Anterior vaginal prolapse repair: A randomised trial of traditional anterior colporrhaphy and self-tailored mesh repair

Abstract

Background. Anterior colporrhaphy has been the traditional standard surgical treatment for anterior vaginal prolapse. However, since it is associated with a 40% recurrence rate, an attempt has been made to resolve the problem of recurrence by means of artificial mesh.

Objective. To compare traditional colporrhaphy with self-tailored mesh in anterior colporrhaphy.

Methods. One hundred and six women were enrolled in a prospective randomised controlled trial and divided into two groups: traditional anterior colporrhaphy (n=54) and anterior self-tailored mesh repair (n=52). The standard pelvic organ prolapse quantification (POPQ) system was used. Women with symptomatic anterior vaginal prolapse ≥POPQ stage II were included. Those with concomitant stress urinary incontinence, dominant posterior vaginal prolapse, active vaginal infections and suspected malignancy were excluded. Outcomes at the end of the procedure, intraoperative and postoperative complications, and follow-up (4 weeks, 6 months,1 year) were noted. Patients were assessed for recurrence (≥POPQ stage II), complications, satisfaction and acceptability.

Results. Postoperative outcome was significantly better than preoperative staging, but no significant difference was seen in the two groups. On follow-up, the primary endpoints (Aa, Ba, tVL) did not differ significantly between the two groups. There were more complications in the mesh group. Satisfaction and acceptability were similar in the two groups.

Conclusion. Although the outcomes in the two groups were similar, duration of surgery and blood loss were significantly greater in the mesh group. The use of mesh in anterior prolapse repair needs to be evaluated further.